Parental self-medication with antibiotics for children promotes antibiotic over-prescribing in clinical settings in Chin
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(2020) 9:150
RESEARCH
Open Access
Parental self-medication with antibiotics for children promotes antibiotic overprescribing in clinical settings in China Jiayao Xu1†, Xiaomin Wang1†, Kai Sing Sun2, Leesa Lin3 and Xudong Zhou1*
Abstract Background: Self-medication with antibiotics (SMA) is one of the most dangerous inappropriate antibiotic use behaviors. This study aims to investigate the impact of parental SMA for children before a consultation on their doctor’s subsequent antibiotic prescribing behavior, including intravenous (IV) antibiotic use in the clinical setting of China. Methods: A cross-sectional survey was conducted between June 2017 and April 2018 in three provinces of China. A total of 9526 parents with children aged 0–13 years were investigated. Data from 1275 parents who had selfmedicated their children and then visited a doctor in the past month were extracted and analyzed. Results: One-third (410) of the studied children had parental SMA before the consultation and 83.9% of them were subsequently prescribed antibiotics by doctors. Children with parental SMA were more likely to be prescribed antibiotics (aOR = 7.79, 95% CI [5.74–10.58]), including IV antibiotics (aOR = 3.05, 95% CI [2.27–4.11]), and both oral and IV antibiotics (aOR = 3.42, 95% CI [2.42–4.84]), than children without parental SMA. Parents with SMA behaviors were more likely to request antibiotics (aOR = 4.05, 95% CI [2.59–6.31]) including IV antibiotics (aOR = 2.58, 95% CI [1.40–4.76]), and be fulfilled by doctors (aOR = 3.22, 95% CI [1.20–8.63]). Conclusions: Tailored health education for parents is required in both community and clinical settings to discourage parental SMA for children. The doctors should not prescribe unnecessary antibiotics to reinforce parents’ SMA behaviors. We recommend expanding the current IV antibiotics ban in outpatient settings of China to cover outpatient pediatrics. Keywords: Antibiotic use, Antibiotic prescription, Medical decision making, Children, Clinical
Introduction Antimicrobial resistance (AMR) is recognized as one of the biggest threats facing global health; inappropriate use of antibiotics, including antibiotic misuse and overuse in both community and clinical settings, is a major contributor to AMR [1, 2]. Self-medication with * Correspondence: [email protected] † Jiayao Xu and Xiaomin Wang contributed equally to this work. 1 Institute of Social Medicine, School of Medicine, Zhejiang University, Hangzhou, China Full list of author information is available at the end of the article
antibiotics (SMA) is one of the most dangerous and prevalent inappropriate antibiotic use behaviors, with a particularly high prevalence in low- and middle- income countries (LMICs) [3–5]. Despite this, antibiotics are the most commonly prescribed medicine for children [6], especially in LMICs where inappropriate antibiotic prescribing is prevalent [7]. A few studies have demonstrated the association between the SMA behavior before a consultation and doctors’ practices in clinical settings. A qualitative
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